Bronchoscopy is an invasive and annoying procedure for the patient. During the course of the bronchoscopy, catecholamine release may occur, with tachycardia and hypertension, which, in patients with compromised cardiovascular function can lead to complications and hemodynamic deterioration.
Nowadays, guidelines recommend offer sedation to patients provided there are no contraindications. Sedation improves patient anxiety, tolerance to test, bronchoscopist and patient comfort, cost-effectiveness (particularly in EBUS), and willingness to repeat the test in case of need.
Different drugs have probe its usefulness for bronchoscopy sedation.
Dexmedetomidine is a potent and highly selective α-2 adrenoceptor agonist with sedative, analgesic, anxiolytic, sympatholytic and opioid-limiting properties. It offers a conscious sedation, in which the patients seem to be inert but really respond easily when stimulated, which allows them to collaborate if necessary.
Its onset of rapid action and its relatively short duration, make it a suitable agent for performing bronchoscopy sedation because it can be easily titrated. It is noteworthy that dexmedetomidine appears to have minimal respiratory depression, which makes it a safe agent in patients who are breathing spontaneously. In addition, it offers potential benefits in relation to neuroprotection, cardioprotection and kidney-protection.

Background: Non-invasive but painful ambulatory urolithiasis treatment, extracorporeal shock wave lithotripsy [ESWL], necessitates immobilization in pediatric age. Appropriate anesthetic agent is crucial for convenient sedoanalgesia, remifentanil generally being used for this purpose. Although dexmedetomidine still not approved by FDA for any pediatric indication, increasing experience with its use in many pediatric scenarios led us to test for ESWL in pediatric patients. So, we compared the hemodynamic, sedative, analgesic and side effects with recovery profiles of dexmedetomidine and remifentanil for ESWL at the pediatric age.Methods: In this prospective, double-blind study, seventy children under going elective ESWL were randomly assigned to a dexmedetomidine [Group D, n=35] or a remifentanil group [Group R, n=35].Results: The procedure was well tolerated in both groups. Heart rate [HR] reduction at 10th and 20th minutes for group R [p<0.05], and at every measurement for group D [p<0.001] with significant low SpO2 values for group R compared to group D at 15 and 20 minutes [p<0.05] were observed. Ramsay scores increased within the individual groups [p=0.001], being higher in group R [p=0.024]. Pain scores were decreased compared to baseline in both groups [p<0.001]; being higher in group R at 5, 10 and 15 minutes [p=0.0001]. Respiratory depression and apnea observed in 20% of patients receiving remifentanil [p=0.011].Conclusion: Both groups provided similar sedoanalgesic effects, yet dexmedetomidine offers comfortable and secure anesthesia with little systemic side-effects along with less respiratory problems suggesting relevance for conscious anesthesia during ESWL at the pediatric age.

Anesthetic management of patient with uncorrected tetralogy of Fallot is a major challenge, especially in developing countries. In these countries, congenital heart diseases are often diagnosed when complications occur. Diagnostic and treatment equipments and medicines are not easily available. We present a case of 30 years old male adult who was scheduled for elective surgical repair of left femoral fracture. He presented with 3 months history of a neglected femoral fracture, associated with language disorder, right hemiparesia due to cerebral abscess and severe hypoxia. During pre anesthetic check-up, an assessment with echocardiography diagnosed a tetralogy of Fallot with interatrial defect. A multidisciplinary discussion involving cardiologists, trauma surgeons, intensivists, anesthesiologists was held. Patient was successfully operated under general anesthesia. After 24 hours of post operative intensive care, he was shifted to the trauma and orthopedics ward and discharged from hospital on 22nd post operative day.

Management of pain, agitation, and delirium in mechanically ventilated patients is one of the foundations of therapy in the intensive care unit (ICU). Dexmedetomidine is a selective, centrally-acting α2 adrenergic receptor agonist with sedative, analgesic, and anxiolytic properties. Pertinent literature regarding the safety and efficacy of dexmedetomidine in mechanically (invasive and non-invasive) ventilated ICU patients is reported. In the mixed medical-surgical population, dexmedetomidine is an appropriate sedative to maintain mild to moderate sedation and has been associated with shorter durations of mechanical ventilation and decreased delirium prevalence vs. benzodiazepine-based sedation. In the post-operative cardiac surgery population, dexmedetomidine may decrease the incidence and/or duration of post-operative delirium as compared to other sedation strategies. More well-designed clinical trials are needed to determine dexmedetomidine efficacy and safety in other ICU populations (i.e. neurocritical care). Preliminary data indicates dexmedetomidine can be safely utilized to facilitate non-invasive ventilation in patients intolerant to such therapy and may be associated with improved clinical outcomes. Bradycardia is the most common reported adverse effect but has not been associated with increased interventions.

Surgery is the most commonly used treatment for cancer patients, particularly in cases of solid tumors. The perioperative period includes various factors that could adversely affect tumour progression. Tumor growth, progression and recurrence depends on the invasive and metastatic potential of the tumor cells, as well as a normal functioning immune system. It has been demonstrated that surgery and anesthesia exert inhibitory effects on cellular immunity favoring metastasis. Inhalational anesthetics reportedly promote tumorigenesison cancer cells in vitro. However, depending on secondary analyses of randomized controlled trials addressing different outcomes and retrospective cohorts, clinical data supportthe use of regional anesthesia/analgesia as a supplement or alternative to general anesthesia with inhalational anesthetics. It is well known that regional anesthesia/analgesia reduces stress responses and reduces the requirement for anesthetic agents and opioids, thereby providing beneficial effects for oncologic patients. Currently available data do not definitively suggest any avoidance or preference for any anesthetic agent or technique for these patients. There are, however, ongoing randomized controlled trials promising definitive results on the subject. It is most likely that simple changes will probably not significantly improve patient survival.